Should Screening for Colorectal Neoplasm Be Recommended in Patients at High Risk for Coronary Heart Disease

Abstract

Colorectal neoplasm (CRN) and coronary heart disease (CHD) share common risk factors. We aimed to assess the risk for CRN in patients who are at high risk for developing CHD determined by measurements, which are independent from the risk factors for CRN.This study was conducted on individuals who underwent total colonoscopic examination and were without history of CHD. Two-hundred thirty-five subjects (82 with CRN and 153 with normal colonoscopic findings) participated in the study. Colorectal carcinoma (CRC) was defined as the presence of adenocarcinoma. We measured carotid intima media thickness (CIMT), flow-mediated dilation (FMD), and calculated Framingham risk score (FRS) for all participants. An increased CIMT (≥1.0 mm), a decreased FMD (<10%), and a high FRS (>20%) were defined as high risks for developing CHD. The risk and the prevalence of CRN were analyzed in relation to the risk for developing CHD.The ratio of the patients with overall-CRN and CRC was significantly higher in individuals who are at high risk for developing CHD compared with individuals who are at low risk for developing CHD by each 3 risk estimation method (P < 0.05 for all). An increased CIMT, a decreased FMD, and a high FRS score were significantly associated with the high risk for the presence of CRC (odds ratio [OR]: 6.018, OR: 3.699, and OR: 4.120, respectively). An increased CIMT, a decreased FMD, and an intermediate FRS were significantly associated with the risk for the presence of overall-CRN (OR: 3.607, OR: 1.866 and OR: 2.889, respectively).The risk for CRN increases as the risk for developing CHD increases. It can be suggested that screening for CRN can be recommended for individuals who are at high risk for developing CHD.

How significant is the association between metabolic syndrome and prevalence of colorectal neoplasia?

“…They found an increased prevalence of advanced colorectal neoplasia in subjects with a high FRS ≥ 10%. Similar results came from a cross-sectional study from Turkey[ 50 ], whose authors showed a significantly increased risk for colorectal neoplasia in patients who were at a high risk for CHD determined by ultrasound measurements of carotid intima media thickness (≥ 1.0 mm), flow-mediated dilation (< 10%) and calculated FRS (> 20%). According to these results, screening for CRC may be recommended for individuals who are at a high risk of developing CHD.…”

<p>Association of Cardiovascular Risk Assessment with Early Colorectal Neoplasia Detection in Asymptomatic Population: A Systematic Review and Meta-Analysis</p>

“…Forty-four records were excluded due to the inclusion and exclusion criteria. Finally, a total of 12 studies [28][29][30][31][32][33][38][39][40][41][42][43] including one study which was identified through cross-references were included. The detailed information of the selection process was presented in Figure 1.…”

“…All studies explored the role of CVD risk assessment method on the detection of AD, and some of them also focused on colorectal high risk adenoma 30,32 and AN. 28,29,38,42,43 Creative Commons license and disclaimer available from: http://creativecommons.org/licenses/by/4.0/legalcode. 36 Abbreviations: CVD, cardiovascular disease; CRN, colorectal neoplasia.…”

“…Higher FRS, estimating the 10-year risk of developing coronary heart disease (CHD), 11,12 was significantly associated with the higher risk of AN (FRS >20% vs. FRS<10%, odds ratio [OR], 4.12, 95% confidence interval [CI]: 1.36-12.52). 28 ABI was associated with 13-fold increased risk of AN in a recent study. 29 CAP and CACS were also found to be positively related to the increased risk of adenoma (AD) and AN in several studies [30][31][32][33] .…”

“…We also observed that less than half of included studies reported the associations of CVD risk with both risk of AN and AD. 28,29,38,42,43 Colonoscopy is considered to as a valid primary screening tool for CRC, and is able to detect both AD and AN. The lower prevalence of AN and the limited number of participants in several included studies might limit the power to explore the relation of AN with CVD risk, which could partly explain why most of studies did not include AN as outcome.…”